SPRINGFIELD – A recent audit has revealed that two health care programs designed to benefit noncitizens in Illinois have far exceeded their original cost estimates, resulting in a staggering $1.6 billion expenditure by last summer. The audit, requested by lawmakers in late 2023, comes at a critical time as Governor JB Pritzker’s budget proposal seeks to defund one of these programs while maintaining the other.

Program Overruns and Enrollment Issues

The audit uncovered significant discrepancies in the enrollment and cost management of the Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) programs. Notably, more than 6,000 individuals enrolled in these state-funded programs were misclassified as “undocumented” despite having social security numbers. Some of these individuals were green card holders who could have qualified for Medicaid or traditional insurance.

Governor Pritzker defended the Department of Healthcare and Family Services’ efforts in redetermining program eligibility, which has led to a reduction in total enrollment. He emphasized the need for universal health care coverage, stating, “It’s some evidence, anyway, that there are an awful lot of people out there who need coverage, who aren’t getting it, or who will do anything to get it. And I think that’s a sad state of affairs in our society.”

Republicans, who have long criticized the programs’ ballooning costs and lack of transparency, have used the audit to support their stance. Senate Minority Leader John Curran, R-Downers Grove, commented, “We’re the only state that puts this burden on Illinois taxpayers taking this on and to not run it properly and to have these large cost overruns, that’s how you end up with a budget deficit. That’s what’s crowding out spending on education. That’s what’s crowding out spending on other components of the state budget. That’s why we need an audit.”

Vastly Underestimated Costs

The HBIS program, created in the early months of the COVID-19 pandemic, was initially estimated to cost $2 million in its first year. However, the actual cost ballooned to over $67 million by the end of 2020. The HBIA program, which covers noncitizen adults aged 44 to 64, cost $485.3 million over its first two years, far exceeding the combined original estimate for both programs.

These programs were designed with the same income eligibility thresholds as Medicaid. However, because federal Medicaid dollars cannot be spent on many types of non-citizens, the state has had to bear the full cost. The audit noted that the Department of Healthcare and Family Services began seeking federal reimbursement for some emergency services last year, but Pritzker indicated that the Trump administration’s policies could halt this reimbursement.

Enrollment and Cost Management

Enrollment in the HBIA program for adults aged 44 to 64 far outstripped original estimates, with nearly 54,000 adults enrolling in fiscal year 2023, about twice the projected 26,800. In response to the escalating costs, Pritzker requested authority to impose spending controls, leading to enrollment freezes in July and November 2023.

Since the enrollment pauses, the programs have not accepted new enrollees, and redetermination efforts have reduced the headcounts. The audit cited a decline in the adults’ program from a high of 53,936 in fiscal year 2023 to 41,537 in fiscal year 2024, which ended June 30.

Mis-enrollments and Policy Implications

The audit also highlighted inconsistencies in enrollment data, with some participants misreporting their status. Nearly 400 individuals had been in the U.S. for the five years required to qualify for Medicaid, while others could have purchased health coverage from the Affordable Care Act’s insurance marketplace.

Governor Pritzker’s proposal to defund the program for adults aged 44 to 64 has reignited debates within the General Assembly. Progressive members of the Latino Caucus have opposed enrollment pauses and efforts to require co-pays for program participants. Pritzker framed his proposal as one of shared sacrifice, stating, “If you come to the table looking to spend more, I’m going to ask you where you want to cut. I have made difficult decisions – including to programs I have championed, which is hard for me, just as I know some of the difficult decisions you will have to make will be hard for you.”

Future Directions and Policy Recommendations

The audit’s findings underscore the need for more rigorous oversight and better cost management in state health care programs. As Illinois grapples with budget deficits and competing priorities, policymakers must balance the need for compassionate health care with fiscal responsibility. The state’s experience with these programs offers valuable lessons for other states considering similar initiatives.

The Pritzker administration’s efforts to seek federal reimbursement and impose spending controls are steps in the right direction. However, further reforms may be necessary to ensure the sustainability of these programs. Policymakers should consider implementing stricter eligibility criteria, enhancing data verification processes, and exploring public-private partnerships to share the financial burden.

Moreover, the audit highlights the importance of transparency and accountability in public health programs. Lawmakers and the public deserve clear and accurate information about the costs and benefits of these initiatives. Regular audits and public disclosure of program data can help build trust and ensure that taxpayer dollars are spent wisely.